Should The Government Require Your Consent To Be An Organ Donor?

Paul Hsieh
, ContributorI cover health care and economics from a free-market perspective.Opinions expressed by Forbes Contributors are their own.

In the US, there’s a significant shortage of donated organs relative to those who need them. According to the United Network for Organ Sharing (UNOS), the non-profit organization that manages the US organ transplant system, there are 117,000 waiting list candidates who need a life-saving organ transplant. Roughly 22 people a day die while waiting for a transplant.

This shortfall frustrates many physicians and organ donation advocates. UNOS notes that 95% of adult Americans support organ donation in theory — but only 54% have actually signed up to be donors.

In response to the shortage, some organ donation advocates have proposed a controversial change in US laws, switching from an “opt in” system to an “opt out” system. In the current “opt in” system, hospitals assume someone is not an organ donor unless they’ve explicitly registered to become one. In the proposed “opt out” system, everyone would be presumed to have consented to donate their organs upon death unless they explicitly “opted out.”

* An “opt out” system still respects individual preferences. Anyone with strong personal or religious convictions against organ donation is not obliged to participate. In theory, there’s no difference between given a default of A with an option to switch to B vs. being given a default of B with the option to switch to A.

* Both “opt out” and “opt in” systems impose transaction costs for those whose preferences don’t match the default option. But if 90% of adults support organ donation, then an “opt out” system imposes that cost on the minority 10%, rather than the majority 90% in an “opt in” system.

* An “opt out” system helps aligns stated preferences with actual results. If 90% of adults *say* they support organ donation, an “opt out” system yields real-world donation rates that matches their words.